US Surgeon General Calls For Cancer Warnings On Alcoholic Beverages

By Laura Cooper & Brianna Abbott

The U.S. surgeon general has called for cancer warnings on alcoholic beverages, citing the drinks as a leading cause of preventable cancers.

Alcohol consumption is the third leading preventable cause of cancer in the U.S., after tobacco and obesity, and is linked to at least seven types of cancer.

The surgeon general's recommendation follows a yearslong debate within the health and scientific community about how much consumption of wine, beer and spirits is safe for adults.

The U.S. surgeon general said alcoholic beverages should carry cancer warnings to increase awareness that the drinks are a leading cause of preventable cancers.

An act of Congress would be required to change the existing warning labels on bottles of beer, wine and liquor. Today, federal rules require only a warning against drunken driving and drinking while pregnant, as well as a general warning that alcohol “may cause health problems.”

“Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States,” Dr. Vivek Murthy said in his advisory issued Friday. “Yet the majority of Americans are unaware of this risk.”

Shares of big beer and spirits companies such as Anheuser-Busch InBev and Diageo fell in Friday trading. The Beer Institute, which represents big brewers, said the beer industry encourages adults of legal drinking age “to make choices that best fit their personal circumstances, and if they choose to drink, to consume alcohol beverages in moderation.”

Alcohol consumption is the third leading preventable cause of cancer in the U.S., after tobacco and obesity. The link between alcohol consumption and cancer risk has been established for at least seven types of cancer, including breast, colorectum, esophagus, liver, mouth, throat and voice box, Murthy said.

The Distilled Spirits Council, a spirits industry group, pointed to recent research from the National Academies of Sciences, Engineering and Medicine concluding that men who consumed two drinks a day and women who consumed one drink a day had lower all-cause mortality rates than people who never drank alcohol. The same report also found a link between alcohol consumption and breast cancer risk.

“Many lifestyle choices carry potential risks,” and the government should consider the entire body of scientific research, the spirits council said.

The surgeon general’s recommendation, in the final days of the Biden administration, follows a yearslong debate within the health and scientific community about how much consumption of wine, beer and spirits is safe for adults.

“Even low levels of alcohol consumption cause cancer,” said Dr. Graham Colditz, associate director for cancer prevention and control at the Siteman Cancer Center in St. Louis. “This is almost one of those pieces that has been ignored by the health recommendations historically.”

For nearly three decades, federal dietary guidelines have said it is safe for men to have two or fewer drinks a day, and for women to have one. That could change this year when the Agriculture and Health and Human Services departments update recommendations that are part of federal dietary guidelines.

For women consuming less than a drink per week, the absolute risk of developing an alcohol-related cancer is around 17%, the surgeon general’s report said. That risk increases to about 22% for women consuming two drinks a day. For men, the risk increases to around 13% from 10%.

Head and neck cancer

Moderate drinkers have a 1.8-fold higher risk of developing oral cavity and throat cancers and a 1.4-fold higher risk of developing larynx or voice-box cancers compared with nondrinkers. Heavy drinkers have a 5-fold higher risk of oral cavity and voice-box cancers and a 2.6-fold higher risk of larynx cancer.

Esophageal cancer

Drinking alcohol at any level is linked with an increased risk of developing cancer in the esophagus, ranging from 1.3-fold higher for light drinkers to 5-fold higher for heavy drinkers.

Breast cancer

Light drinkers have a slightly increased risk of developing cancer—about 1.04-fold higher—than nondrinkers. Moderate drinkers have a 1.23-fold higher risk and heavy drinkers a 1.6-fold higher risk.

Liver cancer

Heavy alcohol consumption is associated with a two-fold increased risk of liver cancer.

Some 47 countries have health warning labels for alcoholic beverages, according to the World Health Organization. South Korea has cancer-specific warnings, and Ireland is set to implement cancer warnings on alcohol products in 2026.

Warning labels prompt some people to change behaviors, and allow others to make more informed decisions, said Noel Brewer, who studies cancer-related health behaviors at the University of North Carolina at Chapel Hill. At least one scientific review found that participants were 26% less likely to choose a product with a health warning label.

Fewer Americans are drinking alcohol now than in previous years because of health concerns, the use of GLP-1 drugs like Ozempic, and changing consumer tastes. Nonalcoholic beers and spirits have gained popularity and younger generations have embraced cannabis.

It is unclear if the surgeon general’s proposal would get bipartisan support in Congress, which hasn’t adopted major legislation on the alcohol industry since 1988, when it passed a law requiring health warnings on all alcohol containers. Cancer risk was part of a federal labeling effort proposed in 1986 in the U.S., but it was abandoned after industry lobbying.

Any change to the current labels could take years, industry analysts say.

Cancer death rates have dropped in recent decades, in part thanks to declines in cigarette smoking. The surgeon general’s 1964 report on cigarette smoking, highlighting its link to lung cancer, helped turn public sentiment against tobacco. Congress in 1965 adopted legislation mandating health warnings for cigarette packs and in 1984 added lung cancer warnings.

Cases of some cancers are rising, and cancer doctors have warned about a troubling increase of cancers such as colorectal among younger people. Researchers are investigating whether alcohol consumption is contributing, as some studies have linked excess alcohol to increased risk for colorectal cancer before age 50.

The surgeon general’s report outlined different ways alcohol consumption can lead to cancer: Alcohol can damage DNA; it can alter hormone levels, increasing the risk of breast cancer; and it can dissolve carcinogens from tobacco smoke, making it easier for them to be absorbed into the body, the report said.

—Nicholas Hatcher contributed to this article.